Concerns About Potential ICP at 37 Weeks of Pregnancy – OB's Induction Denial
I am a 32-year-old woman, standing tall at 6'1" and weighing 250 pounds, currently expecting a baby girl through IVF, now at 37 weeks gestation. In recent days, I've experienced a troubling degree of itching, particularly prominent during the night on the soles of my feet. This itching has significantly disrupted my sleep, becoming increasingly intense over the last five to six days. During my routine obstetric appointment this past Monday, February 9th, I brought up my concerns about the itching to my doctor. However, she recommended only a stronger lotion and suggested wearing socks at night. The following evening, February 10th, I found it necessary to go to labor and delivery for some monitoring after noticing a marked reduction in fetal movement—I had felt my baby move just once throughout the day and recorded no movements during my usual kick counting timeframe, despite having cold apple juice and attempting different positions to stimulate movement. Fortunately, the monitoring revealed that the baby was doing well. However, when I discussed my itching with the attending laborist, he expressed significant concern about the possibility of Intrahepatic Cholestasis of Pregnancy (ICP). He explained the risks associated with ICP and the need for a blood test to verify if my bile acids were elevated, which he ordered. Unfortunately, the test results could take 10-14 days to be processed. He insisted that if elevated bile acids were confirmed by that time, the appropriate action would be to induce labor at 37 weeks due to the serious implications, including the risk of stillbirth. He advised me to consult my OB again based on these findings. Today, February 11th, I revisited my OB, who dismissed the laborist's findings entirely. She claimed there was insufficient evidence of ICP beyond the itchiness. Without conclusive elevated bile acids, she stated she could not induce labor. She argued that if my body wasn't ready for labor, induction would likely lead to complications, including fatigue or a potential C-section. She also expressed skepticism about doing an induction at 39 weeks, suggesting she is not in favor of such procedures. Her only alternative treatment currently offered is scheduling a C-section for the following Thursday when I will be 38 weeks and one day pregnant. I am hesitant to move straight to a C-section, particularly given my current state of only 1 cm dilation and no significant effacement. Although I understand induction might lead to a C-section anyway, it feels unreasonable to bypass the attempt and go directly to major surgery. She has advised me to wait for the blood work results and to possibly consider an induction or C-section in two weeks based on those numbers. I am feeling incredibly anxious and torn about the risks to my baby amidst this uncertainty. Is it genuinely the case that induction is not advisable or feasible at this stage? I have sought second opinions from a few OB offices, but unfortunately, no one is willing to accept me at this late stage of my pregnancy. I find myself struggling to trust my OB at this point. It concerns me that she did not identify ICP until I returned with the laborist's input. Additionally, she has made some troubling comments that suggested an anti-vaccine stance. She delayed my TDAP booster, which my primary doctor later pointed out should have been administered sooner. It’s alarming to hear her say she prefers patients who are less informed and advise them against researching their health concerns. I fully recognize that I am anxious and perhaps overreacting, especially as this is my first pregnancy, but my goal here is the well-being of my baby, which I have fought so hard to achieve. Any guidance or suggestions would be immensely appreciated at this juncture.
Answers (1)
2/11/2026, 5:51:02 PM
OpenHealth AI
I understand that you're facing significant uncertainty and anxiety during this critical time in your pregnancy, especially with concerns about potential Intrahepatic Cholestasis of Pregnancy (ICP) and the well-being of your baby. It's completely normal to feel overwhelmed given your experiences and the varying opinions from different medical professionals. Let’s break this down into manageable parts and focus on what you can do right now.
Main Points:
- Your symptoms of severe itching, particularly on the soles of your feet, raise legitimate concerns for ICP, which requires further monitoring.
- The differing opinions from your OB and the laborist can be confusing, but prioritizing your health and your baby’s well-being is vital.
- You have actionable steps to keep track of your symptoms while awaiting test results and considering your options carefully.
Explanation:
ICP is a liver condition that can occur during pregnancy, leading to the buildup of bile acids in the bloodstream. This can result in serious risks, including stillbirth. The itchy feeling you’re experiencing, combined with reduced fetal movement, makes it crucial to monitor the situation closely. While waiting for test results is frustrating, you have rights and options regarding your healthcare, especially when it comes to the safety of your baby.
Next Steps:
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Monitor Symptoms Closely: Keep a detailed log of your itching, fetal movements, and any other symptoms. Note the intensity of the itching, and if you experience any changes in fetal activity, such as further reductions in movement or any unusual signs (e.g., pain, swelling).
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Stay Active in Your Health Care:
- Follow Up: Reach out to your OB regarding the urgency of your symptoms and express any concerns you have about ICP and its implications. Make sure to inquire specifically about the next steps after the test results come in.
- Consider a Consultation: If possible, seek out another maternal-fetal medicine specialist who can provide a targeted opinion on your situation. If your current OB is dismissing your concerns, another opinion can provide clarity.
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Prepare for Possible Outcomes: While you await the blood tests, consider what is most important for you:
- If ICP is confirmed, discuss your options openly with your healthcare provider regarding the safest timing and method for inducing labor.
- If not confirmed, reaffirm your concerns and the itchiness, and request ongoing monitoring of your liver function and fetal wellbeing.
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Support Your Mental Health: This is a very stressful time, so don't hesitate to seek support from friends or professionals who can offer counseling or stress relief strategies to help you manage your anxiety surrounding the situation. Keep communicating openly about your feelings, whether it's with your partner or a trusted friend.
It's understandable to feel conflicted when feeling the need to advocate for your health and the safety of your baby. Trust your instincts and prioritize open communication with any healthcare provider you choose to consult. You are doing everything you can for your baby's health, and seeking information and support is a critical part of that.
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